HANOI, Vietnam — Nguyen Thuy Lan sits on a tiny plastic stool just inches from the sidewalk, crouched over a steaming bowl of duck noodle soup at a street-side restaurant.

As she works her spoon and chopsticks, chickens peck the ground for scraps at her feet. One scraggly white bird even steals a couple of bites from a nearby pan of freshly made fritters for sale.

No one bats an eye. This is life in Vietnam.

As bird flu rages across the country, killing 12 people here and one in Cambodia in the past six weeks, Vietnamese continue to live among poultry as they have for centuries. And while some say they’ve stopped eating fowl until the current bird flu outbreak wanes, many defiantly vow not to change their habits.

'I'm not scared'
“I’ve heard of bird flu, but I’m not scared,” said Lan, slurping the last bit of juice from her bowl. “There may be bird flu outbreaks elsewhere, but not here.”

Poultry, especially chicken, is everywhere in Vietnam. Birds hang by the neck, roasted golden brown, for sale on bustling sidewalks. They roam freely inside dirt-floor huts in the most remote countryside villages.

Prized fighting cocks are a common sight in parks or on grassy medians as their owners squat beside them, egging them on in fierce, often deadly battles. Owners will even suck blood or phlegm out of the birds’ mouths following a fight.

Experts say bird flu, which has killed 45 people from Vietnam, Thailand and Cambodia over the past year, has become entrenched in Vietnam’s poultry population, where more than a million birds have died or been slaughtered so far this year. But the country’s culture and traditions make wiping out the disease nearly impossible.

Two brothers tested positive for the disease last month after eating raw duck blood pudding, a delicacy in Vietnam. The older brother died, while the younger man, Nguyen Thanh Hung, fought the disease for a week before recovering.

From his hospital bed, Hung said it was a tradition to eat the dish while drinking rice wine at family reunions. Since the duck showed no signs of disease, no one thought there was cause for worry.

“When I was first admitted, I did not remember I had duck blood pudding,” said Hung, who now insists he’ll eat only blood pudding that’s cooked. “I thought my older brother and I suffered some kind of acute pneumonia.”

Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring.

Entrenched habitsVietnamese health officials and the World Health Organization have tried to tell people they must give up certain habits to protect themselves from the virus, which has killed about 70 percent of those infected.

Scientists have said they believe people become infected through physical contact with sick birds — dead or alive — and their droppings, though it is still a mystery exactly how the virus is transmitted. However, well-cooked poultry is not a risk.

“We have no problems with these cultural habits, but in these circumstances ... we think that the people should be more careful,” said Peter Cordingley, spokesman for WHO’s Western Pacific Regional Office in Manila. “It seems to suggest to us that perhaps the messaging still needs to be made a little bit stronger — that there are some cultural habits that might be best temporarily suspended.”

Poultry is a major source of cheap protein for much of Vietnam’s 82 million population. Nearly every household in the countryside raises a handful of chickens or ducks to supplement meager incomes or to keep for eggs or food. Chickens roam freely in most yards and flocks of ducks waddle or swim in rice fields, fattening themselves while spreading their own natural fertilizer — and potential disease.

“In certain parts of Asia, ducks are being moved from field to field, from rice paddy to rice paddy,” said Malik Peiris, the Hong Kong University professor who discovered the SARS virus. “This dramatically increases the opportunity for the spread of infection.”

Most human bird flu cases have been traced back to contact with sick poultry, but the WHO fears the virus will eventually mutate and become easily spread from person-to-person, sparking a global flu pandemic. So far, there is no evidence the virus has changed.

Warnings go unheededDespite nearly three dozen deaths among their countrymen, few Vietnamese have been seriously deterred from consuming poultry.

Le Thi Sang lost her three children during last year’s outbreak after the family served 66 pounds of chicken at her son’s wedding. Her two daughters tested positive for bird flu, while her son died of similar symptoms. Despite her loss, Sang still buys poultry a couple times a week and insists her children were not infected with avian influenza.

“My son and daughter died of pneumonia, while the other daughter died of stomach blooding,” said Sang, 58. “It’s not bird flu.”

The WHO has also warned that slaughtering poultry can be risky if protective gear isn’t worn. A 35-year-old woman and her 13-year-old daughter both died of bird flu last month after they killed a chicken together.

But in a busy Hanoi market, vendor Nguyen Kim Hue says she’s not worried. Standing over a mound of chicken carcasses at her stall, she says she slaughters about 50 birds a day, a routine she’s been following for the past 20 years.

Hue is especially busy this time of year. The Lunar New Year is Wednesday, and chicken is the traditional centerpiece of the meal offered to a family’s ancestors on New Year’s Eve.

Last year, Vietnam banned the sale and transport of poultry over the holiday season as bird flu raged across 10 Asian countries, killing or forcing the slaughter of 100 million birds. No such bans are in place this year, but some wary shoppers say their ancestors will have to accept another dish instead to ring in the Year of the Chicken.

“I stopped eating poultry a long time ago when I heard about the flare-up,” said Tran Thu Ha who stood in a marketplace near a heaping pile of chicken carcasses.